%0 Journal Article %J Fam Pract %D 2012 %T Variation in medical practice: getting the balance right %A Wallace, E %A Smith, SM %A Fahey, T %K clinical practice %K medical interventions %K variation in medical practice %X Contemporary clinical practice is characterized by its complexity as the volume and diversity of medical interventions, whether they are drugs, procedures or diagnostic tests, are increasing and threaten to overwhelm our capacity to deliver patient-centred care. Consider some statistics: the average American citizen can expect to undergo seven operations in their lifetime, 10% will undergo an MRI scan annually (three times higher than the rate in neighbouring Canada) and 50% of Medicare beneficiaries are prescribed five or more medications. In Ireland, one-fifth of the whole population aged over 70 years are taking long-term Proton Pump Inhibitor (PPI) therapy.1–3 The consequences of this phenomenon for patients in terms of benefit (increase quantity and quality of life) versus harm (medicalization of a person, side effects of therapies and costs to the health service budget) give rise to questions concerning the epidemiology of health care utilization and how it differs between and within countries. Seminal work carried out by John Wennberg, a health services researcher and epidemiologist who developed the Dartmouth Atlas Health Project (www.dartmouthatlas.org), has produced an emerging science that examines variation in medical practice and raises important questions about what constitutes ‘appropriate’ health care. This editorial outlines the taxonomy of medical practice variation with clinical … %B Fam Pract %V 29 %P 501-2 %8 2012 Oct %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23008518 %N 5 %R 10.1093/fampra/cms061 %0 Journal Article %J Clinical Evidence (Online) %D 2010 %T Clinical prediction rules in primary care: what can be done to maximise their implementation? %A Keogh, C %A Fahey, T %K clinical practice %K clinical prediction rules %X Clinical prediction rules (CPRs) have become more prevalent in the published literature in recent years. Known by an array ofsynonymous terms including risk score, scorecard, algorithm, guide, and model, CPRs are clinical tools that quantify the contribution ofa patient’s history, physical examination, and diagnostic tests to stratify patients in terms of the probability of having a specific target disorder. Outcomes of CPRs can be presented as diagnosis, prognosis, referral, or treatment. Although not designed to replace clinical knowledge and experience, CPRs do offer a way to assist with the overall diagnostic and prognostic process.[1] Despite the value of these clinical tools, relatively few CPRs have been quantified and their utility validated. One CPR that has gained widespread acceptance is the Centor score,[2] which is based on four clinical features (tonsillar exudate, tender cervical anterior adenopathy, history of fever, and absence of cough) and is used to identify patients with group A beta-haemolytic streptococcal throat infections. What can be done to expedite implementation of other CPRs into routine primary care? %B Clinical Evidence (Online) %8 10/2010 %G eng %U http://clinicalevidence.bmj.com/x/set/static/ebm/learn/678151.html